Value of routine frozen section analysis of urethral margin in male patients undergoing radical cystectomy in predicting prostatic involvement

Purpose: To prospectively investigate diagnostic value of routine frozen section analysis (FSA) of urethral margin for male patients undergoing cystectomy for bladder cancer. Materials and methods: One hundred consecutive male patients were subjected to radical cystectomy for bladder cancer with routine FSA obtained from distal prostatic urethral margin. Definitive pathological condition of the specimens was reviewed to diagnose urethral ± prostatic malignant involvement. The diagnostic value of FSA was identified and compared with different clinical and pathological predictors. Patients with false-negative results were followed for 5 years. Results: Six patients showed evidence of malignancy by FSA of the prostatic urethral margin (one patient was false positive), and all were managed by urethrectomy. Prostatic ± urethral involvement was diagnosed in 15 patients by definitive histopathology (15 %). Sensitivity and specificity of urethral margin frozen section were 33.3 and 98.8 %, respectively, with overall accuracy of 89 % while positive and negative predictive values were 83.3 and 89.4 %, respectively. There was no significant correlation identified between tumor site or morphology, clinical staging, clinically suspicious prostate, cystoscopic involvement of bladder neck, tumor grade, and associated carcinoma in situ or nodal involvement with prostatic malignant involvement. Positive intraoperative FSA was the only predictor significantly associated with malignant urothelial involvement of the prostate. None of the 10 patients with false-negative results developed late urethral recurrence at 5 years. Conclusion: Intraoperative urethral frozen section shows high predictive diagnostic value of malignant prostatic involvement. Nevertheless, its impact in preventing late urethral recurrence is doubtful.